ABC PLAN
401(k) PLAN FEE DISCLOSURE FORM
For Services Provided by XYZ Company1
Overview
The Employee Retirement Income Security Act of 1974, as amended (ERISA) requires employee benefit
plan fiduciaries to act solely in the interests of, and for the exclusive benefit of, plan participants and
beneficiaries. As part of that obligation, plan fiduciaries should consider cost, among other things, when
choosing investment options for the plan and selecting plan service providers.
This 401(k) plan fee disclosure form may assist you in making informed cost-benefit decisions with
respect to your plan. The purpose of this form is to help you determine the total cost of the plan. It is also
intended to provide you with a means to compare investment product fees and plan administration expenses
charged by competing service providers, regardless of how a particular service provider structures its fees.
The 401(k) plan fees included in this disclosure form represent the following: _____ actual 401(k) plan
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expenses for the period X/XX/XX through X/XX/XX or _____ estimated 401(k) plan expenses for the period
X/XX/XX through X/XX/XX. Additional investment product information regarding fees may be obtained
from the product prospectus, annuity contract or other similar documents. Additional information relating
to plan administration services and expenses is contained in documentation provided by the service provider,
including the contract for plan services. Other plan expenses may include legal fees for initial plan design
and ongoing amendments resulting from changes in pension law or plan design and the cost of a mandatory
annual audit. You need to contact your legal advisor or accountant to determine these charges.
Selecting a service provider requires that you evaluate and differentiate services offered by competing
companies. Cost is one of the criteria, but not the only criterion, for making this evaluation. Other factors of
equal or greater importance to consider include the quality and type of services provided, the anticipated
performance of competing providers and their investment products and other factors specific to your plan’s
needs. The service provider offering the lowest cost services is not necessarily the best choice for your plan.
Calculation of Fees
In general, fees are calculated in four ways:
G Asset-based: expenses are based on the amount of assets in the plan and generally are expressed as
percentages or basis points.
G Per-person: expenses are based upon the number of eligible employees or actual participants in the plan.
G Transaction-based: expenses are based on the execution of a particular plan service or transaction.
G Flat rate: fixed charge that does not vary, regardless of plan size.
Fees may be calculated using one or any combination of these methods. Plan administration-related expenses
can also be charged as one-time fees or ongoing expenses. One-time fees are typically related to start-ups,
conversions (moving from one provider to another) and terminations of service. Ongoing fees are recurring
expenses relating to continuing plan operation.
1
There may be plan expenses incurred by other providers, other than the company completing this form. For a complete list of
expenses charged to your plan, please contact all plan service providers with whom you contract or may contract and request fee
information with respect to their services.
2
If you are considering a conversion from an existing plan service provider to a new service provider, you will need to provide the
service provider(s) with certain information about the plan, including the number of plan participants, the number of eligible
participants and the amount of plan assets in order for the service provider(s) to be able to complete this form. Similarly, if you are
considering starting a plan, you will need to provide the service provider(s) with estimates of plan participants and plan assets.
When providing potential service providers with information regarding your plan, it is critical that you provide identical information
to all of the competing companies in order to ensure equivalent comparisons.
ABC PLAN Contact Name:
401(k) PLAN FEE DISCLOSURE FORM Institution:
For Services Provided by XYZ Company Phone:
Total Plan Expenses
Amount/
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I. Investment Product Fees (See Schedule A) Estimate
A. Collective Investment Fund(s) $___________
B. Insurance/Annuity Product(s) $___________
C. Mutual Fund(s) $___________
D. Individually Managed Account(s) $___________
E. Brokerage Window $___________
F. Other Product(s) (Specify) $___________
Total Investment Product Fees $___________
II. Plan Administration Expenses (See Schedule B)
Total Plan Administration Expenses $___________
III. Plan Start-Up or Conversion Related Charges (See Schedule C)
One Time Start-Up/Conversion expenses $___________
IV. Service Provider Termination Related Charges (See Schedule D)
Service Provider Termination expenses $___________
Total Plan Expenses $___________
For definitions of terms used throughout this disclosure form, see Schedule E.
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Amounts are calculated based on rates charged, which are identified in attached schedules as applied to relevant information (for
example amount of assets or number of participants). Certain calculations may be estimates based on information provided by you,
the plan sponsor, and may vary as circumstances change.
ABC PLAN
401(k) PLAN FEE DISCLOSURE FORM
For Services Provided by XYZ Company
Schedule A
Investment Product Fees/Estimates
Collective Investment Assets Management Fee Other✚ Total Cost
Fund (X/X/XX) (Specify)
Fund 1
Fund 2
Fund 3
Fund 4
TOTAL
Insurance /Annuity Assets Management Mortality Risk and Other✚ Total Cost
Product (X/X/XX) Fee Administrative (Specify)
Expense (M&E Fee)
Fund 1
Fund 2
Separate Account 1
Separate Account 2
TOTAL
Mutual Fund Assets Expense Front-end Other✚ Total Cost
4
(X/X/XX) Ratio Load (Specify)
Fund 1
Fund 2
Fund 3
Fund 4
TOTAL
Individually-Managed Assets Management Fee Other✚ Total Cost
Account (X/X/XX) (Specify)
Product 1
Product 2
Product 3
Product 4
TOTAL
✚
Fees represent product-related charges paid by the plan. Fees associated with participants’ transfer of account balances between
investment options, including investment transfer expenses and any contingent back-end loads, redemption fees and surrender charges
should be included in “other” expenses. In addition, any wrap fees or pricing charges for non-publicly traded assets should be
included in the “other” expenses column. For investment product termination fees associated with plan termination or conversion, see
Schedule D. Insurance companies incur marketing and distribution costs, which are recouped through charges assessed against the
plan.
4
Includes 12b-1 fee and management fee. (See the fee table in the fund prospectus).
ABC PLAN
401(k) PLAN FEE DISCLOSURE FORM
For Services Provided by XYZ Company
Schedule A, continued
Investment Product Fees/Estimates
Brokerage Window
5
Assets Commission Transaction Fee Other✚ Total Cost
(X/X/XX) (Range) (Range) (Specify)
Total Transactions
Other Product
6
Assets Management Fee Other✚ Total Cost
(X/X/XX) (Specify)
Product 1
Product 2
Product 3
Product 4
Total Investment Product Fees $______________
5
When providing potential service providers with information/assumptions regarding the brokerage window plan feature, it is
critical that you provide identical information to all of the competing companies in order to ensure equivalent comparisons.
✚
Fees associated with participants’ transfer of account balances between investment options, including investment transfer expenses
and any contingent back-end loads, redemption fees and surrender charges should be included in “other” expenses. In addition, any
wrap fees or pricing charges for non-publicly traded assets should be included in the “other” expenses column. For investment
product termination fees associated with plan termination or conversion, see Schedule D. Insurance companies incur marketing and
distribution costs, which are recouped through charges assessed against the plan.
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Other products could include investment vehicles such as REITs and limited partnerships.
ABC PLAN DISCLOSURE FORM
For Services Provided by XYZ Company
Schedule B
PLAN ADMINISTRATION EXPENSES
Expense Type Rate/ Bundled Service **
Total Cost
* Arrangement
Estimate 7
(✔ )
Administration/Recordkeeping Fees:
G Daily valuation $______________ $____________
G Payroll processing $______________ $____________
G Balance inquiry $______________ $____________
G Investment transfer $______________ $____________
G Contract administration charge $______________ $____________
G Distribution processing $______________ $____________
G QDRO processing $______________ $____________
G Participant statements $______________ $____________
G Plan sponsor reports $______________ $____________
G VRU/Internet services $______________ $____________
G Other (specify) $______________ $____________
Subtotal $__________
Participant Education/Advice:
G Participant education
materials/distribution $______________ $____________
G Education meetings (frequency__ ) $______________ $____________
G Investment advice programs $______________ $____________
G Other (specify) $______________ $____________
Subtotal $__________
Trustee/Custodial Services:
G Certified annual trust statement $______________ $____________
G Safekeeping of plan assets $______________ $____________
G Other (specify) $______________ $____________
Subtotal $__________
* Amounts represent the method by which the fee is calculated, for example as a percentage of plan assets under management, based
upon number of participants or based upon number of transactions. For start-up or take-over situations, fees are based upon estimates
and/or certain assumptions, i.e., regarding assets under management and number of participants. When providing potential service
providers with information/assumptions regarding your plan, it is critical that you provide identical information to all of the
competing companies in order to ensure equivalent comparisons. Without a standardized set of assumptions, service providers will
certainly use differing assumptions, defeating the intended purpose of clarifying fee comparisons among service providers.
7
Services provided under a bundled services arrangement are indicated by a check mark next to the specific service.
** Amounts represent flat dollar amount charges or total charges based upon the particular method of calculation. In some instances,
these amounts represent estimates based on assumptions provided by you, the plan sponsor.
ABC PLAN DISCLOSURE FORM
For Services Provided by XYZ Company
Schedule B, continued
Expense Type Bundled Service **
Rate/ Total Cost
* Arrangement
Estimate
✔
(✔ )
Compliance Services:
G Nondiscrimination testing $______________ $___________
G Signature ready form 5500 $______________ $___________
G Annual audit $______________ $___________
G Other (specify) $______________ $___________
Subtotal $__________
Plan Amendment Fee:
G Plan amendment fee $______________ $___________
G Plan document/determination
letter fee $______________ $___________
G Other (specify) $______________ $___________
Subtotal $__________
Loan Administration:
G Loan origination fee $______________ $___________
G Loan processing fee $______________ $___________
G Loan maintenance and repayment
tracking fee $______________ $___________
G Other (specify) $______________ $___________
Subtotal $__________
Total separate charges $___________
Total bundled services $___________
(Less offsets/credits paid to plan) $(__________)
Total Plan Administration Expenses $___________
* Amounts represent the method by which the fee is calculated, for example as a percentage of plan assets under management, based
upon number of participants or based upon number of transactions. For start-up or take-over situations, fees are based upon estimates
and/or certain assumptions, i.e., regarding assets under management and number of participants. When providing potential service
providers with information/assumptions regarding your plan, it is critical that you provide identical information to all of the
competing companies in order to ensure equivalent comparisons. Without a standardized set of assumptions, service providers will
certainly use differing assumptions, defeating the intended purpose of clarifying fee comparisons among service providers.
** Amounts represent flat dollar amount charges or total charges based upon the particular method of calculation. In some instances,
these amounts represent estimates based on assumptions provided by you, the plan sponsor.
ABC PLAN
401(k) PLAN DISCLOSURE FORM
For Services Provided by XYZ Company
Schedule C
ONE TIME START-UP/CONVERSION EXPENSES
Rate/
* **
Expense Type Estimate Total Cost
G Start-up/conversion education program $ ______________ $________________
G Start-up/conversion enrollment expense $ ______________ $________________
G Installation fee $ ______________ $________________
G Start-up/conversion plan document
fee/filing fee $ ______________ $________________
G Other (specify) $ ______________ $________________
Total Start-up/Conversion expenses $________________
* Amounts represent the method by which the fee is calculated, for example as a percentage of plan assets under management, based
upon number of participants or based upon number of transactions. For start-up or take-over situations, fees are based upon estimates
and/or certain assumptions, i.e., regarding assets under management and number of participants. When providing potential service
providers with information/assumptions regarding your plan, it is critical that you provide identical information to all of the
competing companies in order to ensure equivalent comparisons. Without a standardized set of assumptions, service providers will
certainly use differing assumptions, defeating the intended purpose of clarifying fee comparisons among service providers.
** Amounts represent flat dollar amount charges or total charges based upon the particular method of calculation. In some instances,
these amounts represent estimates based on assumptions provided by you, the plan sponsor.
ABC PLAN
401(k) PLAN DISCLOSURE FORM
For Services Provided by XYZ Company
Schedule D
SERVICE PROVIDER TERMINATION EXPENSES
Rate/
* **
Expense Type Estimate Total Cost
Investment Product Expenses
G Contract termination charges $ ______________ $ ______________
G Back-end load $ ______________ $ ______________
G Product termination fee $ ______________ $ ______________
G Other (specify) $ ______________ $ ______________
Total $ ______________
Plan Administration Expenses
G Service provider termination charge $ ______________ $ ______________
G Service contract termination charge $ ______________ $ ______________
G Other (specify) $ ______________ $ ______________
Total Termination Expenses $ ______________
* Amounts represent the method by which the fee is calculated, for example as a percentage of plan assets under management, based
upon number of participants or based upon number of transactions. For start-up or take-over situations, fees are based upon estimates
and/or certain assumptions, i.e., regarding assets under management and number of participants. When providing potential service
providers with information/assumptions regarding your plan, it is critical that you provide identical information to all of the
competing companies in order to ensure equivalent comparisons. Without a standardized set of assumptions, service providers will
certainly use differing assumptions, defeating the intended purpose of clarifying fee comparisons among service providers.
** Amounts represent flat dollar amount charges or total charges based upon the particular method of calculation. In some instances,
these amounts represent estimates based on assumptions provided by you, the plan sponsor.
ABC PLAN
401(k) PLAN FEE DISCLOSURE FORM
For Services Provided by XYZ Company
Schedule E
DEFINITION OF TERMS
Administration/Recordkeeping Fee: Fee for providing recordkeeping and other plan participant
administrative type services. For start-up or takeover plans, these fees typically include charges for contacting
and processing information from the prior service provider and “matching up” or mapping participant
information. Use of this term is not meant to identify any ERISA Section 3(16)(A) obligations.
Annual Audit: Federal law requires that all ERISA-covered plans with more than 100 participants be audited
by an independent auditor. It is also common to refer to a DOL or IRS examination of a plan as a plan audit.
Any charge imposed by a service provider in connection with this audit is reflected on Schedule B.
Back-End Load: Sales charges due upon the sale or transfer of mutual funds, insurance/annuity products or
other investments, which may be reduced and/or eliminated over time.
Balance Inquiry: Fee that may be charged each time a participant inquires about his or her balance.
Brokerage Commission: A fee paid to a broker or other intermediary for executing a trade.
Brokerage Window: A plan investment option allowing a participant to establish a self-directed brokerage
account.
Bundled Services: Arrangements whereby plan service providers offer 401(k) plan establishment, investment
services and administration for an all-inclusive fee. Bundled services by their nature are priced as a package
and cannot be priced on a per service basis.
Collective Investment Fund: A tax-exempt pooled fund operated by a bank or trust company that
commingles the assets of trust accounts for which the bank provides fiduciary services.
Contract Administration Charge: An omnibus charge for costs of administering the insurance/annuity
contract, including costs associated with the maintenance of participant accounts and all investment-related
transactions initiated by participants.
Contract Termination Charge: A charge to the plan for “surrendering” or “terminating” its insurance/annuity
contract prior to the end of a stated time period. The charge typically decreases over time.
Conversion: The process of changing from one service provider to another.
Distribution Expense: The costs typically associated with processing paperwork and issuing a check for a
distribution of plan assets to a participant. May include the generation of IRS Form 1099R. This fee may apply
to hardship and other in-service withdrawals as well as to separation-from-service or retirement distributions.
Eligible Employee: Any employee who is eligible to participate in and receive benefits from a plan.
Expense Ratio: The cost of investing and administering assets, including management fees, in a mutual fund
or other collective fund expressed as a percentage of total assets.
ABC PLAN
401(k) PLAN FEE DISCLOSURE FORM
For Services Provided by XYZ Company
Schedule E (continued)
Front-End Load: Sales charges incurred when an investment in a mutual fund is made.
Individually Managed Account: An investment account managed for a single plan.
Installation Fee: One-time fee for initiating a new plan or initiating new services.
Investment Transfer Expense: Fee associated with a participant changing his or her investment allocation, or
making transfers among funding accounts under the plan.
Loan Maintenance and Repayment Tracking Fee: Fee charged to monitor outstanding loans and repayment
schedule.
Loan Origination Fee: Fee charged when a plan loan is originally taken.
Loan Processing Fee: Fee charged to process a plan loan application.
Management Fee: Fee charged for the management of pooled investments such as collective investment funds,
insurance/annuity products, mutual funds and individually managed accounts.
Mortality Risk and Administrative Expense (M&E Fee): Fee charged by an insurance company to cover the
cost of the insurance features of an annuity contract, including the guarantee of a lifetime income payment,
interest and expense guarantees, and any death benefit provided during the accumulation period.
Nondiscrimination Testing Expense: Tax qualified retirement plans must be administered in compliance with
several regulations requiring numerical measurements. The fee charged for the process of determining
whether the plan is in compliance is collectively called nondiscrimination testing expense.
Participant: Person who has an account in the plan.
Participant Education Materials/Distribution Expenses: All costs (including travel expenses) associated with
providing print, video, software and/or live instruction to educate employees about how the plan works, the
plan investment funds, and asset allocation strategies. There may be a one-time cost associated with
implementing a new plan, as well as ongoing costs for an existing program.
Plan Document/Determination Letter Fee (Filing Fee): Fee charged for a written plan document. Fee can also
include the costs associated with preparing and filing IRS required documentation, including the request for a
determination letter (document issued by the IRS stating whether the plan meets the qualifications for tax-
advantaged treatment).
Plan Loan: The law allows participants to borrow from their accounts up to prescribed limits. This is an
optional plan feature.
ABC PLAN
401(k) PLAN FEE DISCLOSURE FORM
For Services Provided by XYZ Company
Schedule E (continued)
Product Termination Fee: Investment-product charges associated with terminating one or all of a service
provider’s investment products.
QDRO (Qualified Domestic Relations Order): A judgment, decree or order that creates or recognizes an
alternate payee’s (such as former spouse, child, etc.) right to receive all or a portion of a participant’s
retirement plan benefits.
Separate Account: An asset account established by a life insurance company, separate from other funds of the
life insurance company, offering investment funding options for pension plans.
Service Provider Termination Charge: Plan administrative costs associated with terminating a relationship
with a service provider, with the permanent termination of a plan, or with the termination of specific plan
services. These may be termed “surrender” or “transfer” charges.
Signature Ready Form 5500: Fee to prepare Form 5500, a form which all qualified retirement plans (excluding
SEPs and SIMPLE IRAs) must file annually with the IRS.
Start-up/Enrollment Expense: Costs associated with providing materials to educate employees about the plan,
and enrolling employees in the plan. This may be part of, or included in, the education programs. There may
be a one-time cost associated with implementing a new plan, as well as ongoing enrollment costs.
Trustee Services: Fees charged by the individual, bank or trust company with fiduciary responsibility for
holding plan assets.
VRU: Voice Response Unit.
Wrap Fee: An inclusive fee generally based on the percentage of assets in an investment program, which
typically provides asset allocation, execution of transactions and other administrative services.
12b-1 Fee: A charge to shareholders to cover a mutual fund’s shareholder servicing, distribution and
marketing costs.